Sure you think about diet and exercise as key to
heart disease prevention. But what about the neighborhood you live in?

According to a new study from the Stanford University School of
Medicine, the incidence of heart disease and associated fatalities
are higher for people who live in poor neighborhoods vs. those who
live in more affluent areas.

"This is one of the largest studies to date to show that
neighborhoods exert a pretty powerful influence on your chance of
having a heart attack or stroke," said Marilyn Winkleby, PhD,
professor of medicine at the Stanford Prevention Research Center, who
conducted the study along with colleagues from the Karolinska
Institute in Stockholm and UC-San Francisco. The study appears in the
February issue of the American Journal of Preventive Medicine.

"It's not surprising when you think about the health behaviors
related to heart disease and stroke - physical inactivity, poor
nutrition, smoking - and think about how neighborhoods can influence
these," Winkleby said.

The availability of parks, for instance, or conveniently located
markets with fresh produce rather than fast-food restaurants, may
make a significant contribution toward differing levels of heart
disease, she said.

Researchers analyzed data for the entire Swedish population - 1.9
million women and 1.8 million men living in more than 8,000
neighborhoods. They selected people without any history of coronary
heart disease and then followed them from 1996 through 2000 to
identify initial occurrences of coronary heart disease and subsequent
deaths from heart disease within a year's time of that occurrence.

They found that new cases of heart attacks and stroke were 1.9 times
higher for women and 1.5 times higher for men who lived in
high-deprivation vs. low-deprivation neighborhoods. Census data was
used to determine the level of neighborhood "deprivation," which was
measured by an index of education, income, unemployment and welfare
assistance levels.

Results also showed that the chances of dying from a heart attack or
stroke in the first year after having an event was 1.6 times higher
for women and 1.7 times higher for men in high- vs. low-deprivation
neighborhoods.

Interestingly, even when individual characteristics - such as age,
marital status, family income, education or immigration status - were
taken into consideration, the results remained the same.

"We often think that wealth and education can insulate us from the
assaults of our immediate environment," said Felicia LeClere, PhD, a
researcher with the Population Studies Center of the University of
Michigan who was not involved with the study. "The findings of this
study suggest that this assumption is misguided."

The study is particularly striking as it follows on the heels of a
January study by the California Center for Public Health Advocacy,
which drew a correlation between the availability of fast-food
restaurants in various California counties and incidences of obesity
and related deaths. The more fast-food joints, the higher the obesity rates.

Studies such as these, which show the significant effects of
neighborhoods on heart health, are important for health-care and
government policymakers to take into consideration, Winkleby said.

"This has implications for how we use our health-care dollars," she
said. "We need to rethink health problems to include factors in
neighborhoods, such as building neighborhood parks and providing
accessible grocery stores with quality, affordable produce. Everybody
deserves to live in a healthy neighborhood."

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Stanford University Medical Center integrates research, medical
education and patient care at its three institutions - Stanford
University School of Medicine, Stanford Hospital & Clinics and Lucile
Packard Children's Hospital at Stanford. For more information, please
visit the Web site of the medical center's Office of Communication &
Public Affairs at http://mednews.stanford.edu.

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